Cytology of the Cytology of the Kidney and Adrenal Kidney and Adrenal

GlandGland

Teresa Alasio, MDTeresa Alasio, MD

January 23, 2008January 23, 2008

Kidney and FNAKidney and FNA

Most renal lesions are not candidates Most renal lesions are not candidates for FNAfor FNA– Resected with presumptive dx based on Resected with presumptive dx based on

imaging studiesimaging studies Peds patients – Wilm’s tumor – upstaging Peds patients – Wilm’s tumor – upstaging

purposespurposes

– <10% of renal adult renal lesions are <10% of renal adult renal lesions are candidates for FNAcandidates for FNA

Kidney – Indications for FNAKidney – Indications for FNA Radical nephrectomy is contraindicatedRadical nephrectomy is contraindicated

– Probable advanced stage RCC that is unresectableProbable advanced stage RCC that is unresectable– Possible mets to kidneyPossible mets to kidney– Patient has coincident medical problemsPatient has coincident medical problems– Patient desires investigational treatmentPatient desires investigational treatment

Radiologic findings are equivocalRadiologic findings are equivocal– Atypical cystsAtypical cysts– ““fat free” AMLfat free” AML

Partial nephrectomy is consideredPartial nephrectomy is considered– Small lesion or young patientSmall lesion or young patient– Decreased renal functionDecreased renal function

Abscess is suspectedAbscess is suspected

Specimen Collection and Specimen Collection and PreparationPreparation

AccuracyAccuracy

AdequacyAdequacy

Normal ElementsNormal Elements

GlomeruliGlomeruli Proximal tubular cellsProximal tubular cells Distal tubular cellsDistal tubular cells

Benign lesionsBenign lesions

OncocytomaOncocytoma Renal cortical adenomaRenal cortical adenoma AngiomyolipomaAngiomyolipoma Metanephric adenomaMetanephric adenoma Renal abscessRenal abscess Xanthogranulomatous pyelonephritisXanthogranulomatous pyelonephritis Renal infarctRenal infarct

Renal Cysts - ProblemsRenal Cysts - Problems

Renal Cell CarcinomaRenal Cell Carcinoma

Clear cell/conventional RCCClear cell/conventional RCC Papillary renal cell carcinomaPapillary renal cell carcinoma Chromophobe renal cell carcinomaChromophobe renal cell carcinoma Sarcomatoid renal cell carcinomaSarcomatoid renal cell carcinoma Collecting duct carcinoma (Bellini Collecting duct carcinoma (Bellini

tumor)tumor)

Urothelial CarcinomaUrothelial Carcinoma

Metastatic TumorsMetastatic Tumors

Adrenal GlandAdrenal Gland

MyelolipomaMyelolipoma

Adrenal Cortical NeoplasmsAdrenal Cortical Neoplasms

PheochromocytomaPheochromocytoma

Metastatic TumorsMetastatic Tumors